In some cases (Figure 5), the causal chain of events leading to death is unclear. If there is an element of uncertainty, the use of qualifiers such as “probable” and “suspected” is acceptable. In general, the degree of certainty required of a natural death tester is “more likely than not” (i.e., with a reasonable degree of medical probability, the deceased has expired for the causes listed on the death certificate).2,14 Especially in cases of older deaths, it can be difficult to prioritize the conditions leading to death. Because there are often several medical comorbidities. and they appear to die with (not of) their illness.14 Terms such as “senescence”, “infirmity” and “advanced age” should be avoided because age is already documented elsewhere on the death certificate.1 If there is no medically probable cause of death, it may be necessary to request an autopsy or notify the M/C. A “pending” death certificate may be issued pending the results of autopsy or other critical tests. In Wisconsin, a supplemental certificate must then be issued to the state registrar within 30 days of the declaration of death.15 Note that it is not necessary to use all the lines in Part I, as noted above. Conversely, additional rows can be added if necessary. Find cause of death information for MR&C for medical certifiers and additional resources for medical certifiers. In this example (Figure 7), the patient suffered from urosepsis, which appeared as a direct complication of the neurogenic bladder due to a paralyzing gunshot wound to the spine. The manner of death in this case would be considered homicide, despite the many years that have passed since the injury.2,14,16 In general, if the cause of death can be clearly attributed to the effects or complications of the injury, the case should be reported to an ME/C office, regardless of the interval between injury and death. In the elderly, hip fractures would be a common example of this principle.
Hip fractures put patients at high risk of secondary diseases such as infections and thromboembolic events; It has been reported that one in five elderly patients with a hip fracture dies within a year of an injury.19 If a hip fracture was sustained in a fall after which the patient never returned to basic function and death occurs due to the sequelae of the fracture, the manner of death would be an accident.14,20 In general, if death had not occurred, If the patient did not sustain a previous traumatic injury (or acute drug toxicity), the manner is considered unnatural. It should be noted that, according to the convention, even if an injury or drug toxicity is only listed as a compassionate disease in Part II, the unnatural condition prevails and determines the manner of death in the case.20 In most states, there is a specific time frame within which the death certificate must be submitted. For example, Wisconsin state physicians are required to complete and return the medical portion of the death certificate within 6 days of the date of the death announcement,3 and it is considered a Class I crime to “intentionally and knowingly” provide false information on a death certificate.4 Despite the importance of an accurate death certificate, Mistakes are common. Studies conducted in various academic institutions have found errors in the cause of death and/or type of death certificate in approximately 33% to 41% of cases,5–7 with a disproportionate overrepresentation of cardiovascular causes of death.8,9 The most frequently cited reasons for serious certification errors include lack of experience on physicians (e.g., general practitioners) and lack of adequate certificate training. of death. When short educational interventions such as didactic seminars or the distribution of printed instructions are performed, error rates decreased significantly.7,9 In a study of 200 general practitioners who were asked to complete a statement of cause of death from a pirouette for hospital deaths, only 15.5% correctly identified the cause of death. After a workshop or review of printed guidelines, 84.5% were able to correctly identify the cause of death.9 The following exam is designed to educate medical certifiers on the basic principles and common pitfalls of electronic death records and certification to improve accuracy. While some of the principles discussed here apply to perinatal deaths, the general issue of perinatal death certificates (i.e., fetal and infant) presents very different practical considerations and challenges that are beyond the scope of this review. The death certificate is an important legal document.
In addition to providing a cause of death for the family of the deceased, it has critical administrative and epidemiological applications. Death certificates may be required to settle the deceased`s estate and to obtain insurance or other pensions or benefits. In many states, a death certificate is required prior to cremation or burial. At both the state and national levels, mortality data compiled from death certificates are used to track disease trends, set public health policies, and allocate funds for health and research.1,2 For these reasons, it is important that death certificates are completed completely. accurately and in a timely manner. Funeral home staff enter the deceased`s information into MR&C. This includes the name of the deceased, dates of birth and death, place of death, type of disposition, and name of medical certifier. Death registration is a joint effort. Generally, a funeral director enters the legal and demographic information of the deceased into MR&C.
MR&C will then notify the medical certifier. The medical certifier adds the cause and type of death to MR&C to complete and certify the death record. What types of deaths should be investigated? (1) Physicians, authorities in hospitals, sanatoriums, public and private institutions, convalescent homes, authorities of a similar facility and other persons who have knowledge of the death of a deceased person in any of the following circumstances shall immediately report the death to the sheriff, chief of police or coroner or coroner of the district where the death occurred: (e) All deaths due to poisoning, whether murder, suicide or accident. (g) if, in the 30 days preceding the death, there was no physician or accredited practitioner of a bona fide religious denomination who relied on prayer or spiritual means of healing. In this example (Figure 9), the patient developed acute pancreatitis superimposed on chronic pancreatitis due to chronic alcohol abuse. Consequences of chronic alcohol abuse such as pancreatitis, alcohol withdrawal attacks, or alcoholic cirrhosis are commonly referred to as natural deaths.2,15 Other common examples of chronic substance abuse leading to natural deaths include endocarditis due to chronic intravenous drug use, chronic obstructive pulmonary disease due to smoking, or oral cancer due to tobacco chewing. Conversely, deaths due to acute toxicity of a substance, such as acute alcohol intoxication, cocaine-induced delusion, or acute toxicity to several drugs, are commonly referred to as accidents or suicides (depending on whether there was evidence of intent to self-harm or cause death).2,15 Note that if death occurs due to the foreseeable toxicity of a substance, It is used medically to treat an underlying natural disease. is prescribed (e.g., sepsis, which occurs as part of chemotherapy bone marrow immunosuppression for malignancy), death would generally be classified as natural.2,15 The condition listed in the bottom line of Part I (i.e., the underlying cause of death) is arguably the most important, as it is usually coded as the cause of death. Global mortality data are coded according to the current ICD-10 (International Statistical Classification of Diseases and Related Health Problems) system published by the World Health Organization (WHO).16 The system facilitates the interpretation and comparison of mortality data by translating the cause of death into an alphanumeric code for a specific disease or injury. From a public health perspective, the most effective strategy is to prevent the triggering illness or injury that triggered the chain of events leading to death.16 For this reason, it is important to carefully weigh the underlying causes.